OAKLAND, Calif., Dec. 17, 2013 /PRNewswire/ -- The duration of diabetes, as well
as advancing age, independently predict diabetes severity and risk of death for
older adults with type 2 diabetes, according to a study published online in JAMA
In this study led by Kaiser Permanente and the University of Chicago,
researchers investigated contemporary rates of diabetes complications and risk
of death, then contrasted them across categories of age and duration of
diabetes. More than 72,000 patients aged 60 or older with type 2 diabetes were
drawn from the Kaiser Permanente Northern California Diabetes Registry.
"The need to individualize care for older patients with diabetes is widely
accepted. However, the current approaches do not adequately account for risk
differences by age or duration," said senior author Andrew J. Karter, PhD, a
senior research scientist with the Kaiser Permanente Division of Research. "For
example, the risk of hypoglycemia rose markedly and independently with advancing
age and duration of diabetes. This finding is notable because hypoglycemia is
known to be caused by the treatment for diabetes. It concerns us that one of the
most common negative outcomes in diabetes is a side effect of treatment."
The researchers assessed acute hyperglycemic (high blood sugar) and hypoglycemic
(low blood sugar) events; microvascular complications such as end-stage kidney
disease, diseases of blood vessels outside the heart and brain, lower extremity
amputation and advanced eye disease; cardiovascular complications such as
coronary artery disease, cerebrovascular disease or stroke and congestive heart
failure; and all causes of death related to diabetes.
For a given age group, rates of each outcome, particularly hypoglycemia and
microvascular complications, increased dramatically with longer duration.
However, for a given duration of diabetes, rates of hypoglycemia, cardiovascular
complications and death increased steeply with advancing age, while rates of
microvascular complications remained stable or declined.
"Many older patients are living longer with their diabetes, and longer duration
of diabetes is associated with more complications and more difficulty with
maintaining glycemic control," said lead author Elbert S. Huang, MD, MPH, of the
University of Chicago. "Understanding the contemporary clinical course of
diabetes in older patients is the critical first step needed to individualize
and prioritize care, and target support for future research efforts."
The researchers say these findings suggest the need for increased clinical and
research focus on reducing and understanding the incidence of hypoglycemia for
older adults with diabetes. For policymakers, the study provides important data
that may be used for projecting health care expenditures for a large and growing
segment of the Medicare population. More importantly, the data from this study
may inform the design and scope of public policy interventions that meet the
unique needs of those who live with the disease.
This research is part of Kaiser Permanente's body of work focused on better
understanding diabetes. Earlier this year, Kaiser Permanente researchers found
that patients with diabetes who take certain types of medications to lower their
blood sugar sometimes experience severe low blood-sugar levels, whether or not
their diabetes is poorly or well controlled.
Additional authors on the study include Jennifer Y. Liu, MPH, and Howard H.
Moffet, MPH, of the Kaiser Permanente Division of Research in Oakland, Calif.;
Neda Laiteerapong, MD, MS, and Priya M. John, MPH, of the Section of General
Internal Medicine at the University of Chicago.
About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates
epidemiologic and health services research to improve the health and medical
care of Kaiser Permanente members and the society at large. It seeks to
understand the determinants of illness and well-being and to improve the quality
and cost-effectiveness of health care. Currently, the Division's 550+ staff are
working on more than 350 ongoing research studies in behavioral health and
aging, cancer, cardiovascular and metabolic conditions, health care delivery and
policy, infectious diseases, vaccine safety and effectiveness, and women's and
children's health. For more information, visit www.dor.kaiser.org.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We
are recognized as one of America's leading health care providers and
not-for-profit health plans. Founded in 1945, our mission is to provide
high-quality, affordable health care services and to improve the health of our
members and the communities we serve. We currently serve 9.1 million members in
eight states and the District of Columbia. Care for members and patients is
focused on their total health and guided by their personal physicians,
specialists and team of caregivers. Our expert and caring medical teams are
empowered and supported by industry-leading technology advances and tools for
health promotion, disease prevention, state-of-the-art care delivery and
world-class chronic disease management. Kaiser Permanente is dedicated to care
innovations, clinical research, health education and the support of community
health. For more information, go to: kp.org/share.
Josh Weisz, Golin Harris for Kaiser Permanente, 202-585-2614
Ann Wallace, Kaiser Permanente Northern California, 510-891-3653
SOURCE Kaiser Permanente